Don’t just take away the Xbox: Psychiatrist

The details emerging from a tragic national story about a missing boy in Canada point to an important observation about videogaming: that taking away a videogame (or device it's played on) does not have the same effect as taking away a toy or conventional game. Fifteen-year-old Brandon Crisp of Barrie, Ontario, missing for more than two weeks, left the house angry after his father took away his Xbox console. His father told the Toronto Globe and Mail that "this has become his identity, and I didn't realize how in-depth this was until I took his Xbox away." His mother "would wake in the middle of the night to hear … Brandon, speaking into his headset as he feverishly played [the Xbox game] 'Call of Duty 4: Modern Warfare'," the Globe and Mail reports in another article, adding that his parents are "sure Brandon had become addicted to the game and link its appeal" to his disappearance.

Portland, Ore.-based psychiatrist Jerald Block emailed me a heads-up about this story last weekend. So I took the opportunity to ask him, one of the US's leading experts on videogame addiction, how this kind of addiction can be treated – what I can tell parents about that. He started and ended with that question, but in the middle of his answer are some very helpful insights for anyone who cares about or works with an addicted gamer – parents, friends, educators, policymakers – into the impact that sudden removal from a videogame's world can have….

Why game addiction's hard to treat

How to treat this addiction is "a good question," Dr. Block wrote me, "and one that I hate because it has no easy answer. I have treated many cases and I am still trying to figure out what works best and for whom. But here's what I've learned about gaming in general and gamers of all ages: Gaming is particularly hard to treat as it is 1) enjoyable, 2) an outlet for despair/anger/sex, 3) readily available, 4) time-consuming and thus fills in otherwise unpleasant 'spaces' in one's life, 5) a social forum with Virtual or simulated people, 6) a source of power, and 7) a portrayal of a fair, equal world.

"When people elect to voluntarily give all that up, they generally struggle with their mood and anger. If they are *forced* to give it up, all those emotions become amplified; any fanciful notions of power or control are trampled when they're disconnected against their will.

"Also, unplugging the computer can vividly demonstrate how intangible and fragile the Virtual is and can lead to existential crisis. This is a complex concept, but I consider it crucial. People are spending 30, 40, 50, or more hours a week powering up and getting success on their computers. They work hard at mastering the games and technology. They make significant sacrifices in terms of time and effort. The mastery becomes representative, in a psychological sense, of one's self-worth.

What is reality?

"Now disconnect the computer or console. You have summarily dismissed those accomplishments – the fantasy, the power, and that alternate life, heavily invested in (and mind you sometimes that alternate life may seem a whole lot better than the Real one). Now take it a step further: If someone could so easily destroy such an important thing that, although Virtual, seemed quite Real, isn't it also possible that our flesh-and-blood reality is yet another deception or illusion? To gamers – given the story lines they 'live' in – this is not as far-fetched as it may sound. Philosophers and religious leaders have discussed this for hundreds of years. It does sound pretty disturbing (or disturbed) – the concept that we might not actually exist but are, instead, merely some other being's dream or, as Oxford philosopher Nick Bostrom recently wondered, merely simulations running in a simulated society? Such concepts can sound bizarre, but when in history have people actually been able to live them in very real-seeming environments – on so massive a scale, and at such young ages? More than 10 million people worldwide regularly play World of Warcraft, and that's just one such environment/game. I doubt the concept that life might actually be yet another illusion is hardly foreign to WoW's players. It is actually commonplace enough, the subject of numerous films (e.g., The Matrix) and even parody (the Onion's 'World of World of Warcraft' video).

"What I am getting at, here, is that – whatever your philosophy happens to be about how we define 'reality' – I believe the more one starts to believe he or she exists only as a piece of code running in some meta-computer (as some of my patients have done), the less valuable life becomes – your own life, others' lives, and the ethics by which you live. If one's life isn't real and one is just a puppet in some meta-being's 'game,' then it can come to feel like what one does in Real Life doesn't matter much.

Understanding the gamer's needs

"These are some of the risks of abruptly stopping computer or videogame use. As for treatment, one option is to cut someone off in the context of an extended (2+ weeks) camp where he or she is left physically or mentally exhausted. In doing so, you are wisely substituting rewards in the Real for those being lost in the Virtual. For example, at a well-structured camp, there are not an extra 30 hours to fill each week after work or school, and people form relationships with others who are enduring the same hardships. If it sounds something like boot camp in the military … well, depending on your age, that is a therapeutic option worth considering.

"The alternative to 'cutting the cord' is to talk with the person and try to understand his perspective. Maybe he thinks his gaming is more helpful than harmful, maybe not a problem at all. So, first come to understand what the patient feels. If you feel the computer use is counterproductive and she doesn't, discuss why the two of you seem unable to understand one another's perspectives. Nothing will happen until she becomes motivated to change herself. If, eventually, the patient comes to believe as you do – that the computer or game use is excessive and destructive – then you can try to agree on goals to cut back on it. Part of that discussion will entail trying to address what needs the computer was satisfying and what one can do instead.

"The process tends to be very gradual – progress is measured in weeks or months – and it is therapy-intensive. Obviously, it is not the 'quick fix' that we want and need. What do I suggest parents do? I don't honestly know. If it were my child, I would first start by setting limits. I would avoid cutting him off from his technology for more than a few consecutive days and would avoid using computer restrictions punitively. If limit-setting failed and the compulsive play got worse, I would punt and take him to see a therapist."